The Cost of Cochlear Implantation: A Review of Methodological Considerations

Objectives. Cost studies can provide useful guidance, so long as they adhere to accepted methodology. Cochlear implants (CIs) are electronic devices introduced surgically into the inner ear. It is a relevant example to review cost study analyses because of its costliness. The aim of this study was to review relevant published cost studies of CI to analyze the method used. Methods. First, we described the key points of cost study methodology. Cost studies relating to CI were systematically reviewed, focussing on an analysis of the different methods used. Results. The methods, data sources, and estimated cost categories in each study varied widely. The paper showed that cost studies adopted significantly different approaches to estimate costs of CI, reflecting a lack of consensus on the methodology of cost studies. Conclusion. To increase its credibility, closer agreement among researchers on the methodological principles of cost studies would be desirable

Myocardial T1-mapping for early detection of left ventricular myocardial fibrosis in systemic sclerosis

International audiencen.

Effect of Cyclosporine on Left Ventricular Remodeling After Reperfused Myocardial Infarction

ObjectivesThis study examined the effect of a single dose of cyclosporine administered at the time of reperfusion on left ventricular (LV) remodeling and function by cardiac magnetic resonance 5 days and 6 months after myocardial infarction.BackgroundIn a human study, administration of cyclosporine at the time of acute reperfusion was associated with a smaller infarct size.MethodsTwenty-eight patients of the original cyclosporine study had an acute (at 5 days) and a follow-up (at 6 months) cardiac magnetic resonance study to determine LV volumes, mass, ejection fraction, myocardial wall thickness in infarcted and remote noninfarcted myocardium, and infarct size.ResultsThere was a persistent reduction in infarct size at 6 months in the cyclosporine group compared with the control group of patients (29 ± 15 g vs. 38 ± 14 g; p = 0.04). There was a significant reduction of LV end-systolic volume (and a trend for LV end-diastolic volume; p = 0.07) in the cyclosporine group compared with the control group, both at 5 days and 6 months after infarction. There was no significant difference between the 2 groups in either global LV mass or regional wall thickness of the remote noninfarcted myocardium at 5 days or 6 months. Attenuation of LV dilation and improvement of LV ejection fraction by cyclosporine at 6 months were correlated with infarct size reduction.ConclusionsCyclosporine used at the moment of acute myocardial infarction reperfusion persistently reduces infarct size and does not have a detrimental effect on LV remodeling. These results are preliminary and must be supported by further studies. (Ciclosporin A and Acute Myocardial Infarction; NCT00403728

La Chambre Calorimétrique : utilisation à visée épidémiologique

La Chambre Calorimétrique : utilisation à visée épidémiologique. Journée de la Recherch

Analyse longitudinale des variations de la composition corporelle et du métabolisme de base d’adolescents obèses pris en charge en institution ou à domicile

Mémoire originalNational audienceThe prevalence of obesity in children has increased dramatically during the past decades, and requires efficient care. OBJECTIVES: To determine changes in anthropometric parameters and basal metabolic rate (BMR) in obese adolescents during and after 2 types of weight-reduction programs. SUBJECTS AND METHODS: Twenty-six adolescents (group I, Z-score of BMI = 4.72) followed a 9-month-weight reduction program including a moderate energy restriction and regular physical activities in a specialized institution. In addition, 39 adolescents (group E, Z-score of BMI = 2.83) followed at home a 9-month-weight reduction program including medical and dietetic advices. Body composition (by impedancemetry) and BMR (by indirect calorimetry) were assessed before the beginning (M0), 4 months after (M4) and at the end (M9) of the programs, then 4 months (M13) and 16 month (M25) after the end of the weight-reduction programs. RESULTS: Twenty-two adolescents in group I and 20 adolescents in group E completed the study. At M0, age, body weight (BW), fat-free mass (FFM) and BMR of subjects of group I were higher (1.0 year, 36 %, 30 % and 23 %, respectively, P < 0.001), than those of group E. Pubertal stage and percentage of fat mass (FM) were not significantly different between the 2 groups. At M9, adolescents of group I showed significant reductions in BW and FM (-19 and -37 %, respectively, P < 0.001), but not significant differences in FFM. In addition, BMR decreased significantly between M0 and M4, both in absolute value (-6.7%, P < 0.001) and after adjustment for FFM (-5.8%, P < 0.001), and the difference was maintained until M9. Between M9 and M13, BW and Z-score of BMI were maintained in 12 adolescents, but increased (+9.7% and 14.8%, respectively, P < 0.001) in 10 adolescents. However, BMR did not change significantly in all adolescents. Between M13 and M25, BW, FM, FFM and BMR increased significantly (+13%, +34%, +6% et +5%, respectively, P < 0.001). During the 25 month period, adolescents of group E showed significant increases in BW, FFM and BMR (+8%, +14% and +10%, respectively, P < 0.001), and maintained their Z-score and FM. CONCLUSION: The reduction in BMR during the weight-reduction program at the institution could contribute to body weight regain in the post-obese adolescents if they do not maintain the lifestyle habits taught during the weight-reduction period. In other respects, Z-score was stabilized in 51% of domiciled obese adolescents.La prévalence de l’obésité infantile est en augmentation permanente et nécessite une prise en charge efficace. OBJECTIF: Analyser l’évolution des principaux paramètres anthropométriques et du métabolisme de base (MB) d’adolescents obèses pendant et après deux types de prise en charge : intensive en institution ou conventionnelle à domicile. SUJETS ET METHODES: Vingt-six adolescents âgés de 12 à 16 ans (Z-score de l’IMC = 4,72) ont suivi en institution (groupe I) un programme de réduction pondérale de neuf mois comprenant une restriction énergétique modérée et une activité physique régulière. Un deuxième groupe de 39 sujets de même âge (Z-score de l’IMC = 2,83) a bénéficié d’un suivi médical et diététique bimestriel au domicile des parents (groupe E). Les mesures de composition corporelle (impédancemétrie) et du MB (calorimétrie indirecte) ont été réalisées avant le début (M0), après quatre mois (M4) et neuf mois (M9) de prise en charge, puis quatre mois (M13) et 16 mois (M25) plus tard. RESULTATS: Deux et quatre des 26 adolescents du groupe I n’ont pas participé respectivement aux mesures aux temps M13 et M25. À M0, l’âge, le poids, la masse maigre (MM) et le MB des adolescents du groupe I étaient supérieurs à ceux des adolescents du groupe E, mais le stade pubertaire et le pourcentage de masse grasse (MG) n’étaient pas significativement différents entre les deux groupes. À M9, les adolescents du groupe I présentaient des diminutions du poids et de MG de 19 et 37 %, respectivement (p < 0,001), mais pas de variation significative de la MM. Le MB a diminué entre M0 et M4, tant en valeur absolue (–6,7 %, p < 0,001) qu’après ajustement pour les différences de MM (–5,8 %, p < 0,001) et la différence s’est maintenue jusqu’à M9. Entre M9 et M13, le poids corporel et le Z-score de l’IMC des adolescents du groupe I n’ont pas varié significativement chez 12 adolescents, mais ils ont augmenté significativement chez dix adolescents (+ 9,7 et 14,8 %, respectivement, p < 0,001) ; en revanche, le MB n’a pas varié significativement pour l’ensemble des adolescents. Entre M13 et M25, le poids corporel, la MG, la MM et le MB ont augmenté significativement pour l’ensemble des adolescents (+ 13 %, + 34 %, + 6 % et + 5 %, respectivement, p < 0,001). Dix-neuf des 39 adolescents du groupe E ont abandonné progressivement la prise en charge. Pour la plupart d’entre eux le poids et le Z-score de l’IMC avaient augmenté. En revanche, les 20 adolescents du groupe E qui ont suivi la prise en charge pendant les 25 mois n’ont pas présenté de variations significatives de leur IMC et du MB ajusté pour les différences de MM. CONCLUSION: La prise en charge en institution a été très efficace à court terme. Cependant, la diminution du MB observée au cours du programme de réduction pondérale a favorisé la reprise de poids des adolescents post-obèses qui n’ont pas maintenu les habitudes de vie acquises au cours de la période de prise en charge. La moitié des adolescents qui ont bénéficié d’une prise en charge à domicile et ont participé pendant les 25 mois au suivi hygiénodiététique ont stabilisé le Z-score de leur IMC

Comment évaluer les compléments alimentaires à visée cosmétique ?

International audienceRelations between skin and ageing, hydratation and sun were mainly targeted by cosmeto-foods. For each of these relation, in vitro and in vivo techniques exist in cosmetology to evaluate benefits of products under development. In a legal way, these cosmeto-foods depend on French food complement legislation. It is thus subjected to no preliminary marketing authorization. These products evaluation may carry out after marketing by the french safety and food agency (AFSSA). Nutritionnists members of AFSSA ask for a scientific justification of allegations advanced by firms developing these products. Knowing techniques used in cosmetology allows an objective evaluation and permit to require a proof level in adequacy with the advanced allegations.Le marché des compléments alimentaires à visée cosmétique se développe. Ceux ci concernent principalement les relations entre la peau et le vieillissement, le soleil, et l’hydratation. Pour chacune de ces relations des techniques in vitro et in vivo existent en cosmétologie pour évaluer le bénéfice des produits en cours de développement. D’un point de vue légal, ces compléments à allégations cosmétiques dépendent de la législation du complément alimentaire. Il n’est donc soumis à aucune autorisation préalable de mise sur le marché. L’évaluation de ces produits sur saisine est effectuée a posteriori par l’Agence Française de Sécurité Sanitaire des Aliments. Les nutritionnistes membres de l’AFSSA demandent une justification scientifique des allégations avancées par les firmes développant ces produits. Connaître les techniques utilisées en cosmétologie permet une évaluation objective de ces produits et d’exiger un niveau de preuve en adéquation avec les allégations avancées

Cost-Effectiveness Analysis of Vaginal Misoprostol versus Dinoprostone Pessary: a large noninferiority RCT in France

International audienceObjective: To assess the cost-effectiveness of vaginal misoprostol (PGE1) (25μg) compared to a slow-release dinoprostone (PGE2) pessary (10μg) for labor induction due to an unfavorable cervix at term. Methods: We used data from an open-label multicenter, randomized noninferiority trial which recruited women for whom labor was induced for medical reasons, a Bishop score ≤ 5 at ≥ 36 weeks, and a cephalic-presenting singleton pregnancy with no prior cesarean delivery. The Incremental Cost Effectiveness Ratio (ICER) was assessed from the payer’s perspective, with the focus on inpatient care costs and using the Caesarean Deliveries Avoided (CDA) rate as primary analysis and the rate of Vaginal Delivery within 24h (VD24) as secondary analysis. Results: Analyses were based on 790 women in each group. Differences between treatment arms were the mean cost per patient of €4,410 and €4,399, a CDA rate of 80.1% and 77.9% and a VD24 rate of 46.1% and 59.4% for dinoprostone and misoprostol respectively. Dinoprostone is not cost-effective according to the CDA and misoprostol was either a cost-effective or a dominant strategy according to the VD24. Conclusion: Misoprostol and dinoprostone have equal cost management with mixed efficacy according to the clinical outcome used. Finally, misoprostol may be an attractive option for hospitals since the price is lower and it is easier to use